The following Adobe Acrobat file provides you with the Patient Bill of Rights and Responsibilities provided by Renaissance Surgical Center - North, LLP. Should you have any questions regarding these please feel free to contact a member of our staff at 281.446.4053 and they shall ensure that your questions are answered.

Patient Bill of Rights and Responsibilities

• Friendly, considerate and respectful care at all times and full recognition of your individuality, including your personal privacy.
• Complete information, to the extent known by the physician regarding your diagnosis, treatment and prognosis, as well as alternative treatments or procedures and the possible risks and side effects associated with such treatment.
• Full and complete information on the scope of services available at the facility, its provisions for after-hours and emergency care and an itemized bill of all related fees for services rendered.
• Disclosure regarding physician financial interest or ownership in the facility.
• Impartial access to treatment irrespective of race, color, sex, national origin, religion, age or disability.
• Make decisions about your medical care, including your right to accept or refuse medical or surgical treatment and your right to initiate advance directives such as a living will or durable power of attorney. If you already have a living will or other directive or you wish to initiate one, you may request further information on our facility’s policy regarding advance directives and living wills from one of our staff members.
• Be a participant in decisions regarding the intensity and scope of treatment. If you are unable to participate in those decisions, your designated representative or other legally designated person may exercise your patient rights on your behalf.
• Approve or refuse the release of medical records to any individual outside the facility, except in the case of transfer to another facility, or as required by law or third-party payment contract.
• Refuse treatment to the extent permitted by law and be informed of the medical consequences of such a refusal. You, as the patient, accept responsibility your actions should you refuse treatment or not follow the instructions of the physician or facility.
• Information regarding any human experimentation or other research/educational projects affecting your care or treatment and you may refuse participation in such experimentation or research without compromise to your usual care.
• Express grievances or complaints at any time and report comments regarding the quality of services provided and be entitled to a fair follow-up to your commentary.
• Express those spiritual beliefs and cultural practices that do not harm or interfere with your planned medical therapy and have these considered in communications made to you and your families
• Change your primary and specialty care physicians or dentists if other qualified physicians or dentists are available.
• Access to and copies of your medical records
• Be fully informed before any transfer to another health care facility or organization

PATIENT RESPONSIBILITIES

As a patient, you have the responsible for:

• Providing, to the best of your knowledge, the most accurate and complete information about your present health status, past medical history, illnesses, hospitalizations, medications, unexpected changes in condition or any other relevant patient health matters.
• Reporting whether you clearly understand the planned course of treatment and what is expected of you and ask questions when you need further information.
• Being considerate of other patients and personnel and for assisting in the control of noise, smoking and observing the prescribed rules of the facility during your stay and treatment. If facility policies are violated, you may forfeit the right to care and bear responsibility for your actions.
• Respecting the property of others and the facility
• Promptly fulfilling your financial obligations to the facility.
• Making payments to the facility for any copies of medical records you request.
• Providing information about and/or copies of any living will, power of attorney, or other directive that you would like us to know about prior to treatment.

Presenting any concerns and complaints:

Presentations of complaints will not serve to compromise your future care at our facility. If you have any concerns or complaints about your visit to Renaissance Surgical  Center – North, LLP, you may present your concerns, verbally or in writing, to the:

Administrator
Julie McKay-Smart
281.446.4053

Clinical Director
Stacey Brown
281.446.4053

Department of Health Services, Facility Licensing Group
1100 West 49th Street, Austin, TX 78256
Phone: 1.888.973.0022

Medicare Beneficiary Ombudsman, for Medicare inquiries and complaints at their contact information below:

Phone: 1.800.MEDICARE
Website: www.medicare.gov/ombudsman/resources.asp